This is a competitive renewal application for occupational health & safety research with the ultimate goal of providing a healthy, productive home care (HC) workforce. HC aides are the fastest growing occupation in the U.S., and the accelerating trend towards more medical care at home increases the urgency to identify HC aides' work hazards and prevent associated injuries and illness. Cleaning and disinfection (C&D) is a major part of the daily work of HC aides because of the growing risks from multi-drug resistant organisms like methicillin resistant Staphylococcus aureus (MRSA) and Clostridium difficile (C diff). Yet at the same time, there is growing evidence that many C&D chemicals widely used for infection prevention are associated with respiratory illnesses. Cleaning products are among the leading causes of occupational asthma. Currently, occupational respiratory health and infection prevention efforts are disconnected, creating a gap in our ability to fully protect HC workers. The proposed research will develop an integrated, multidisciplinary approach that optimizes occupational respiratory health and effective C&D for infection prevention, rather than trading off one for the other. This will be accomplished with the following specific aims: 1) Determine the extent to which pathogens and other micro-organisms found on surfaces in the home care environment can be reduced by different types of C&D. 2) Evaluate respiratory exposures and health effects from C&D as practiced in HC environments. 3) Synthesize the findings from aim 1 and 2, translate and disseminate them for HC stakeholders. The proposed research addresses the NIOSH National Occupational Research Agenda (NORA) sector of Healthcare and Social Assistance (HCSA) and addresses sector priority areas of Chemical Hazards and Infectious Diseases. The HC occupations addressed are employed both in healthcare and social assistance services. The NORA cross-sector programs addressed are: 1) Exposure Assessment; 2) Respiratory Diseases; 3) Prevention through Design; and 4) Occupational Health Disparities. The expected outputs will be quantitative and qualitative data and communication products to serve the expected outcome of providing the evidence base for guidance on safe, effective C&D in HC. Research to Practice (r2p) methods will be engaged at all stages of the proposed research in collaboration with our well-established, successful HC industry partnership network to insure that the findings are relevant and disseminated to the practice communities that can use them for preventive workplace interventions. Expected intermediate outcomes of the proposed research are an improved understanding of the OSH risks and benefits of C&D and an integrated evaluation of the OSH dimensions of C&D that can contribute to the evidence base for good practice guidelines in HC. The end outcome of this work is expected to be a healthier and more productive HC aide workforce.